Capitol Hill Hearing Underscores Urgent Need for Mental Health Reform

The Energy and Commerce Subcommittee on Health held a hearing yesterday on landmark legislation that would reform the U.S. mental health system.

The bill, HR 2646 (Helping Families in Mental Health Crisis Act), is cosponsored by U.S. Reps. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas). It builds on previous legislation put forward by both representatives.

Notably, the bill creates the position of Assistant Secretary for Mental Health and Substance Use Disorders, who must be a psychiatrist or Ph.D. clinical psychologist, within the Department of Health and Human Services to elevate the importance of mental health in that agency, coordinate mental health and related programs across different agencies, promote effective evidence-based programs, and ensure compliance with the mental health parity law.

Much of yesterday's discussion hovered around HIPAA and whether that law prevents clinicians from giving families information about the diagnosis, treatment, or appointment scheduling of relatives with mental illnesses. HR 2646 would allow disclosure in some circumstances of health information covered by the privacy rule to families or caregivers when it is in the best interests of a patient who lacks decisional capacity.

This was indeed a gray area for clinicians, said former APA President Jeffrey Lieberman, M.D. (pictured above). “Doctors fear lawsuits, and it will take more than education to solve this problem.”

Speaking in favor of the bill, Lieberman pointed out that "mental health care involves disease management, not handing out a pill. It is hard to provide because we lack co-location of services and a coherent funding stream. The tools for care are available, but we have to develop the policies to implement them. We need a big-picture approach."

"Severe mental illness is a brain disorder, and it has to be seen and treated for what it is," said Joe Pitts (R-Pa.), subcommittee chair. "This bill is comprehensive and is a big first step and makes substantial changes."

Overall, further collaboration on the bill should maintain a focus on the needs of patients, Murphy concluded. “We’ll keep working together.”

For more information on HR 2646, go to Rep. Murphy's website; also, see "APA Applauds U.S. Reps. Murphy and Johnson for Reintroducing Comprehensive Mental Health Reform Legislation."

(aml/Image: Aaron Levin)

Reps. Murphy, Johnson Reintroduce House Mental Health Reform Bill

Rep. Tim Murphy (R-Pa.) and Rep. Eddie Bernice Johnson (D-Texas) reintroduced the Helping Families in Mental Health Crisis Act (HR 2646) yesterday. The revamped bill builds upon the previous bipartisan version introduced last year.

“It’s not just a new bill, but marks a new dawn for mental health care in America,” Murphy (pictured above during address to the APA Assembly last year) said in a statement. “We are moving mental health care from crisis response to recovery, and from tragedy to triumph. I am tremendously proud of the work we’ve accomplished and so encouraged about our nationwide grassroots support involved in advancing our legislative vision to help families in mental health crisis.”

According to a summary of the bill prepared by Murphy’s office, the bill seeks to address, among other issues, the following:

Innovation. Establishes a National Mental Health Policy Laboratory to drive innovative models of care and develop evidence-based and peer-review standards for grant programs and dedicates funding for the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.

Improving Transition From One Level of Care to Another. Requires psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to appropriate post-hospital care and services.

Shortage of Crisis Mental Health Beds. Provides additional psychiatric hospital beds for those experiencing an acute mental health crisis and in need of short-term (less than 30 days) immediate inpatient care for patient stabilization.

Mental Health Workforce. Requires the assistant secretary for mental health and substance use disorders to study and recommend a national strategy for increasing the number of psychiatrists, child and adolescent psychiatrists, and other mental health professionals; includes child and adolescent psychiatrists in the National Health Service Corps; and authorizes the Minority Fellowship Program.

Early Intervention and Prevention Programs. Authorizes, for the first time in federal law, the Recovery After Initial Schizophrenia Episode (RAISE), an evidence-based early intervention program, and launches a new early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.

Alternatives to Institutionalization. Incentivizes states to provide community-based alternatives to institutionalization for those with serious mental illness, such as assisted outpatient treatment and other assertive-care community approaches.

APA leaders hailed the introduction of the bill as a critical step toward mental health reform. “The nation’s mental health system needs reform and investment—especially on behalf of patients and families living with serious mental illness. We applaud Reps. Murphy and Johnson,” said APA President Renée Binder, M.D. “Among the many important provisions of this bill are strengthening enforcement of mental health parity, enhancing the psychiatric workforce, ensuring better coordination of federal resources, and improving research and treatment for persons with mental illness, including substance use disorders.”

Added APA CEO and Medical Director Saul Levin, M.D., M.P.A.: “We look forward to working with Congress to pass this bill this year."

A summary of the bill is posted at http://murphy.house.gov/uploads/Summary_The_Helping_Families_in_Mental_Health_Crisis_Act.pdf. For more information, see the Psychiatric News article “Author of House Mental Health Bill Addresses APA Assembly.”

(Image: David Hathcox)